— 生理適應 · HARD · MCQ —
一位病人肺葉切除術後放置胸管，下列何種觀察結果需要立即處理？
A nurse is caring for a client with a chest tube following a lobectomy. Which observation requires immediate intervention?
- AClient reports pain at the insertion site when coughing咳嗽時插入部位感到疼痛
- BSmall amount of sanguineous drainage in the collection chamber收集室中有少量血性引流液
- CFluctuation of fluid in the water seal tube with inspiration水封管內的液體隨吸氣波動
- DContinuous bubbling in the water seal chamber✓ 正解水封室持續冒泡
— Explanation · 中文詳解 —
水封瓶持續氣泡通常代表胸腔內存在空氣外洩（air leak），例如胸膜破裂或導管接頭鬆脫。正常狀況應僅在咳嗽或深呼吸時有間歇性氣泡。持續性氣泡若非系統密封不全，則暗示肺部仍有氣胸，需評估系統密合度並通知醫師。
Continuous bubbling in the water seal chamber indicates an air leak in the system—either at a connection, the insertion site, or from the lung itself (e.g., bronchopleural fistula). Normal bubbling is only intermittent with coughing or deep breathing. Persistent bubbling requires assessment of system integrity and provider notification because of the risk of tension pneumothorax.
✦ 台美臨床差異
胸管護理在兩地皆屬高標準無菌操作，台灣護理師更常被要求記錄引流量與氣泡性質的密切變換。